What May Look Like Scalp Psoriasis

Scalp psoriasis, especially if mild, can often resemble other very common conditions that affect the scalp. The two most common conditions that scalp psoriasis are often confused with are, Dandruff, and Seborrheic Dermatitis, a more severe counterpart.

Both conditions are extremely common, and have similar symptoms such as itchiness, redness, and scaling. As these conditions are far more common than scalp psoriasis, if the symptoms are very mild, you may be diagnosed incorrectly.

Compare the three conditions

Dandruff:

• Covers most of the scalp
• Dandruff is small; you won't be able to feel it with your hands
• Dandruff varies widely in severity. Extremely severe ones are classified under seborrheic dermatitis.
• Very common, affecting 15% to 20% of the population at any given time.
• Symptoms are generally easy to control
• The tendency to develop dandruff appears to be genetic.
• Dandruff is a condition that requires constant managing via medicated shampoos.
• All people shed skin from the scalp. Those with dandruff do so at a faster rate, which can make flakes visible to the naked eye.
• Itchiness is common, and severity of itch will vary from person to person.
• Scales are small and fine

Seborrheic Dermatitis

• Seborrheic dermatitis is an inflammatory disorder of the skin affecting the scalp
• Often flares up during winter and early spring, and recedes during the summer
• Seborrhiec dermatitis can also affect the face and the torso
• Sebum rich areas of the skin are often affected
• Yeast called Malassezia is likely a factor
• Hair loss can occur but is usually insignificant
• Antifungals and antiyeast shampoos are often effective
• Common condition in babies (cradle cap) and adults between 30 to 60

Scalp Psoriasis

• Occurs in patches
• Often lumpy, caused by scales that are stuck together by the hair
• Very common in those who have psoriasis
• Silvery sheen, powdery
• Can vary from mild scaling to thick crusted plaques
• Can extend on to the forehead, the neck, and ears
• Can itch
• Scraping off the scale will often reveal a small dot, which bleeds, called the Auspitz sign
• Localized hair loss may be seen. Hair loss is temporary.
• Scraping or itching the psoriasis can cause it to appear in other areas of the scalp. Though psoriasis is not caused by fungus, virus, or bacteria, it can affect sites of damaged skin via a process called the koebner phenomenon.

The differences

Scalp psoriasis is a type of psoriasis while dandruff and seborrheic dermatitis are unrelated conditions that cause inflammation in the skin.

• Scalp psoriasis is very common, affecting up to 50% of people with psoriasis. If you have other forms of psoriasis, there is a good chance that it may affect your scalp. If you do not have a history of psoriasis, the doctor may check for other signs of psoriasis to make a diagnosis.
• Very often, people with scalp psoriasis have other subtle signs that point to psoriasis such as pitted nails or mild psoriasis on the elbows or knees.

Seborrheic Dermatitis is often seasonal, while psoriasis is generally unaffected by season.

• Seborrheic Dermatitis often flares up during the winter months or early spring, and recedes during the summer. Scalp psoriasis can flare unexpectedly, regardless of the season. For some people, stress, injury, or infection can trigger flares.

There are subtle differences in appearance

• Scales from scalp psoriasis are often larger and thicker
• Scales from scalp psoriasis tend to be silvery and dry while scales from seborrheic dermatitis are often more yellow and greasy looking
• Scaly patches will often extend beyond the hairline in scalp psoriasis, while in seborrheic dermatitis the patches will usually remain confined to the hairline
• Scales from seborrheic dermatitis are removed easily, while scalp psoriasis scales may bleed or become sore when removed. A small dot that bleeds when the scale is removed, called the auspitz sign, also point at psoriasis

You can often feel scalp psoriasis by running your hand through your scalp

• Psoriasis scales tend to clump where there is plenty of hair, as scales pile on top of each other and are tangled with hair
• Mild to moderate cases of seborrheic dermatitis will not scale so severely that it tangles with hair.
• Scales will often fall off without much resistance in the case of seborrheic dermatitis.
• Generalized redness and scaling can be seen around the nose area where there are a lot of oil glands in the case of seborrheic dermatitis